First Name:	*
Last Name:	*
Home Phone:	*
Work Phone:
E-mail:	*
State Of Residence:	Pick One KS MO OTHER *
County Moving To:	Pick One Cass, MO Clay, MO Platte, MO Jackson, MO Johnson, KS Miami, KS Wyandotte, KS Other *
City preference:	*
# Bedrooms:	Pick One 1 2 3 4 5 6 or More *
#Bathrooms Full:	Pick One 1 2 3 4 5 6 or More *
# Garages:	Pick One 0 1 2 3 4 or More *
Price Range:	Pick One Under 100,000 100,000 to 200,000 200,000 to 400,000 400,000 to 800,000 Over 800,000 *
I want to buying in:	Pick One I am Ready now! 1 - 3 Months 4 - 6 Months 7 or More Months *
Best Contact Time:	Pick One Morning Afternoon Evening Any Time *
I Want FREE Home Search Access and the TopPros FREE Buyer Agent Service:	Pick One YES NO *
Relocation Plans:	Pick One I am in the market for a New Home I am in the market for a resale home *
Present Living Status:	Pick One I currently own my home I currently rent *
What type of mortgage will you apply for?	Pick One 1 yr. arm 3 yr arm 5 yr. arm 15 yr. Fixed 30 yr. Fixed Interest Only FHA Va Undecided *
Financial History:	Pick One Excellent Good Fair Poor *
Are you selling your home?	Pick One YES NO *
Is your home currently listed?	Pick One YES NO *
How did you hear	Newspaper	Radio KBEQ 104
About TopPros:	ABC KMBZ 9	Radio KCMO 710
	CBS KCTV5	Radio KMBZ 980
	Yard Sign	Magazines
	Internet	Realtor.com
	Billboards	Other
Were You Referred?	Pick One Yes No
.	If yes, Please provide the referring parties  name and your relationship so we can properly thank them
	If you are currently working with a TopPros agent please enter their name in the space provided..

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